Redefining what’s possible in healthcare: An interview with John E. Gallina
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What is the main topic discussed in this episode?
This is McKinsey on Healthcare, a podcast series about visionaries, leaders, and problem solvers shaping the future of healthcare.
This is Shubham Singhal. I'm here with John Golina, Chief Financial Officer of Anthem. Welcome, John. Why don't we start with just your view on what you see as the most significant trends in healthcare?
What major healthcare trends and challenges does John Gallina identify?
As you know, there are many difficult challenges in the healthcare industry today. In addition to the rapid pace of change, affordability and access to quality care are significant issues, and they're significant for employers, consumers, the government, and society.
John, you spoke a bit about affordability. What are some of the big areas that you see within that that have to get addressed?
Health insurance obviously is a function of the price of health care.
How do rising drug and treatment costs drive affordability concerns?
And whether it's the increasing cost structure associated with specialty pharmacies, new medications on the market, inpatient procedures that are helping extend people's lives, they do cost money. All of these things help push the affordability issue to the forefront within the health care industry.
You also mentioned on technology and consumer behavior. Do you see that helping with affordability?
technology will help provide better data and better insights and provide a more educated consumer base and provide better information to the physicians who can actually come up with evidence-based medical decisions in treating the patient. From an insurance company perspective, we have access to all of the most recent data And we can package that information and provide it to the providers so that the providers can make the best evidence-based medicine decisions and help improve the health outcomes of the patients. There are a lot of new entrants into the market. and everyone's trying to accumulate data everyone's trying to have access to this information but where we see it's really beneficial is the collaboration that we're doing with the providers given the fact that we have leading market share in most of the markets that we operate we have more information than anyone else within those markets and then we take that data
and then we can provide information back to the providers when they're in their office and they access the system and they look at our integrated healthcare data set where they can look at, for a particular member, not only what their health information is, but also what's their pharmacy information, what's their behavioral health information, what's their dental information, what's their vision information, so that they have all that information together in one single sign-on
How can technology and data improve care decisions and affordability?
Again, so that they can then make the best decisions and provide the best care to the members. The collaboration with the providers, that really makes a huge difference.
What is the impact of some of these changes in healthcare to your business?
Given the complexity of the healthcare ecosystem, there are no simple answers.
What does the evolving healthcare landscape mean for the CFO role?
Yet at Anthem, we have the power to lead and shape the conversation by partnering and innovating across the system to create real value for our stakeholders. This means leading the transition from fee-for-service to value-based care by collaborating with providers to provide flexible payment models, enhance data sharing, and reduce administrative burdens. And we've been very successful. As of today, 64% of our total medical spend is tied to payment innovation programs, including payment-based contracts, leads the entire industry. We need to demonstrate our value to employers, the states, and the federal government. And that means providing affordable products with an array of price points and features for employers, while simplifying and improving the healthcare experience for their employees and their families.
How is Anthem shifting from fee-for-service to value-based care?
If I were to switch now to your role in this industry that is changing, what does it mean for your role as Chief Financial Officer?
My traditional role is CFO of Anthem. I have oversight for the finance functions, and I also oversee all the actuarial functions, including underwriting and pricing, product development, forecasting and valuation.
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Chapters
7 chapters
1
What is the main topic discussed in this episode?
0:06–0:26
2
What major healthcare trends and challenges does John Gallina identify?
0:26–0:54
3
How do rising drug and treatment costs drive affordability concerns?
0:54–2:50
4
How can technology and data improve care decisions and affordability?
2:50–3:10
5
What does the evolving healthcare landscape mean for the CFO role?
3:10–4:02
6
How is Anthem shifting from fee-for-service to value-based care?
4:02–5:12
7
What lessons about culture, alignment, and change does Gallina share?
5:12–8:49
Speakers
2 identifiedMore from McKinsey on Healthcare
Nishaminy Kasbekar on centralizing pharmacy in patient care
Kevin Mahoney on the responsibility of academic medical centers
Brian Evanko’s on affordable, personalized healthcare
Eric Larsen on the emergence and potential of AI in healthcare
Warehouse to wellness: Bob Mauch on modern pharmaceutical distribution
Leading a best-in-class health system integration